[7] As a result of hot temperatures and inadequate preparation, more than 184 people died in the state of Bihar,[8] with many more deaths reported in other parts of the country.

The water crisis was exacerbated by high temperatures and lack of preparation, causing protests and fights that sometimes led to killing and stabbing.

The Indian Institute of Tropical Meteorology has identified several contributing factors, including "El Niño Modoki", an irregular El Niño in which the central Pacific Ocean is warmer than the eastern part, and the loss of tree cover, which reduces shade, increasing temperatures, and reduces moisture in soil, which results in less evapotranspiration and more heat transfer into the atmosphere.

[19][20] In response to the growing number of deaths from heat waves, the Indian government, although not addressing the root causes, began implementing measures intended to save lives in 2013.

In Ahmedabad, for example, "school days were reduced, government work programs ceased, and free water was distributed in busy areas."

For comparison, the 2003 European heat wave killed an estimated 35,000–70,000 people,[29] with temperatures slightly less than in India and Pakistan.

[30] Droughts and water shortages have occurred in multiple states and provinces across India and Pakistan,[31] worsening heat wave conditions.

[14] In early June, fifteen monkeys were found dead in a forest in Madhya Pradesh, possibly as a result of the heat wave.

[33][34] The Indian National Disaster Management Authority (NDMA) had a goal for keeping heat related deaths this year to single digits.

In 2018, the heat wave death toll was kept at 20 through public safety measures; for example, government workers across the country conducted awareness campaigns and distributed free water.

[35] In early June, the Indian Meteorological Department issued a severe heat wave warning in Rajasthan and nearby areas such as Delhi.

[14] On 17 June, the government of Gaya, a city in Bihar, imposed Section 144 to be active, which empowers an executive magistrate to prohibit an assembly of more than four persons in an area, and banned construction work and assemblies between 11 a.m. and 4 p.m.[24] The Pakistan Medical Association urged people to learn about the measures to avoid heat-related deaths.